In
the past four decades, advancements in the operation — which involves
grafting a tendon from the forearm into the elbow to act as a ligament —
and the rehabilitation process have cut the standard recovery period
nearly in half.

“With
the number of people playing overhead sports who have an injury to the
U.C.L., this is an international phenomenon, allowing athletes from all
over the world to keep up their level of play,” said Dr. Bradford
Parsons, the chief of shoulder surgery at the Icahn School of Medicine
at Mount Sinai in New York.

Dr.
David Altchek, the medical director for the Mets and a co-chief in the
Sports Medicine & Shoulder Service at the Hospital for Special
Surgery in New York, said baseball patients were amazed to learn that
the condition was not caused by an improper pitching style.

“Really,
really good technique increases it the most,” he said, adding that as
players got bigger and stronger, the need for surgery would only
increase.

The
efficiency of the operation has prompted some parents of teenage
athletes to ask whether the procedure is appropriate without a diagnosis
of a torn ligament, based partly on an assumption that the operation
improves arm strength.

Dr.
Spero Karas, the director of the Emory Orthopaedic Sports Medicine
Fellowship Program in Atlanta, said he discouraged surgery for anything
short of fixing a tear of the ligament.

At the same time, he said he was not surprised that more athletes, especially pitchers, were having the operation.

“Kids
are superspecialized now,” Karas said. “As the pressure to excel
increases, where livelihoods depend on a player’s success, driving guys
into the ground becomes unfortunately all too common.”

“We
think it’s a very successful surgery, especially given where it has
come in a short period of time,” said Dr. Frederick Azar, chief of staff
at Campbell Clinic Orthopaedics in Memphis. “It’s a lot better
operation from where it started out.”

It has evolved to where surgeons can select from several approaches.

One
option, developed by Altchek, is known as the docking technique, in
which fewer holes are drilled in the humerus bone and the graft is
looped in differently. The docking approach also uses a less invasive
tactic known as muscle-splitting, in which the surgeon enters the
affected area between muscles rather than removing and later reattaching
a muscle.

Altchek said the approach achieved “the same thing with a little less trauma for the athlete.”

“I
liken it to a golfer with his ball 3 feet off the green,” Karas said,
adding that putting or chipping from that distance could be equally
effective.

The operation does raise questions, including whether the elbow winds up stronger than before.

The
inserted tendon that replaces the damaged ligament is stronger, doctors
agree, but most say it is unclear if the elbow’s biomechanics become
upgraded.

Athletes
often convince themselves that is the case, although the feeling may be
explained more by high-degree exercises and treatment of the elbow that
the athlete was not previously receiving.

Further
shortening the time frame for recovery remains “probably the next
hurdle to leap over,” Azar said. He added, “We are happy with it now,
but we’d like to trim it down.”

Attempts to accelerate rehab have mostly misfired.

“A
lot of us have tried to push this envelope, and we’ve failed,” Altchek
said. At some point, the thinking goes, the body must heal at its own
pace.

“But
when you compare how far we’ve come in 40 years, that’s pretty good,”
Karas said, alluding to the 18 months of rehabilitation John needed.
With some pitchers, depending on when the surgery was conducted, “we’ve
given them a year back,” Karas said.

Doctors who were acquainted with Jobe said they would remember him as
much for his unwavering care for each patient and his humility as for
his contribution to sports medicine."...image, "Tommy John pitching for the
Yankees in 1989, 15 years after Dr. Frank Jobe repaired his elbow. John,
who had won 124 games before the pioneering surgery, went on to win 164
more.Credit
Stephen Dunn/Allsport"

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